Tick-borne Diseases in the Czech Republic

Ticks may be very small and barely noticeable parasites, but they are prevalent and are known to spread a number of serious illnesses. In the Czech Republic, the occurrence of tick-borne diseases is among the highest in Europe. Some of these diseases include Lyme disease, tick-borne meningoencephalitis and Ehrlichiosis. Although all can be serious, most attention should be paid to Lyme disease and tick-borne meningoencephalitis given the large number of individuals infected each year. We met up with Dr. Yanová from Canadian Medical Care ask for some expert advice and to learn more about tick borne illnesses.

Tick-borne meningoencephalitis

Ticks carry a virus, belonging to the group of Flaviviruses /same group as dengue fever/, which is the cause of tick-borne meningoencephalitis. Ticks can transmit this virus at any developmental stage. After a tick-bite occurs, the virus is introduced into the bloodstream of the host and multiplies. The disease has two characteristic phases.

In the first, some 1-2 weeks following infection, flu-like symptoms occur; patients suffer from headache, sore throat, muscle aches and an increased temperature. All of these symptoms then appear to subside within several days. The second phase is more serious and often affects the central nervous system. In this stage, symptoms can range from meningitis, meningoencephalitis (inflammation of the brain and meninges), all the way to meningoencephalomyelitis (inflammation of the brain and the spinal cord and meninges).

The damage can be very serious and the symptoms at this stage include severe headache, nausea, vomiting, light sensitivity and various neurological symptoms ranging from stiffness of neck to nerve paralysis. The infection may also affect breathing and heart function, sometimes leading to death. After the most acute phase is over, patients often find that they still experience problems with concentration, memory problems, headaches and peripheral limb paralysis.

Lyme disease

Lyme disease is also caused by tick bites, but this time the culprit is a bacteria called Borrelia burgdorferi.

Typical initial symptoms begin a few weeks after a tick bite and include fever, headache, fatigue, and a characteristic skin lesion called erythema migrans. This is usually a red area with a white center and the size ranges from a few centimeters to several tens of centimeters wide. Children sometimes show a different characteristic lesion, so called borrelial lymphocytoma, which is a small bluish red nodular swelling that is almost always on the lobe of the ear, nose or the areola of the nipple.

If this early stage is left untreated, infection can spread to joints, the heart, and the nervous system. Facial paralysis is one possible consequence. However, up to 30% of all cases do not show any first stage symptoms and the patient finds himself/herself directly in the second phase, which is more difficult to treat. The third and final stage involves immunopathologic reactions of our body and is often evident through inflammations of the skin, the heart, lungs, the spinal cord as well as the eyes.

Treatment and immunization

Treatment of Lyme disease with antibiotics is effective, if the disease is diagnosed early. However if the disease is not diagnosed in time, irreversible changes may occur. There is currently no vaccination available as the only one that was available in the past (in the late 1990s) has been pulled from the market for its low effectiveness and side-effects.

A very effective and safe vaccine is however available for tick-borne meningoencephalitis. The vaccine is recommended for children older than one and immunization is recommended in the spring in three doses (1,2 and 6-12 months). Booster doses are recommended every 3-5 years to maintain immunity. Since there is no causative treatment available, vaccination is the best measure to adopt as further treatments are only supportive in nature. Early diagnosis is still important, much like with Lyme disease, as hospitalization and rest improve recovery of patients.

Other preventive measures and tick removal techniques

Given the widespread presence of ticks in the Czech Republic, it is often difficult to prevent ticks biting you or a member of the family. Since they are mostly distributed in grassy and forested areas, you are likely to come across them in city parks in Prague or anywhere else you may travel across the country. There are for example some higher risk areas such as regions around Pilsen, Brno or South Bohemia when it comes to tick-borne meningoencephalitis. For Lyme disease, the northern as well as the south-east regions of the country are areas with greater amounts of reported cases.

To minimize the chance of a tick biting you, wear clothes that cover as much as possible when visiting the forest or spending time in grassy areas. Ticks often find themselves in areas with heavy grass growth near river beds and near animals that they depend on for survival. There are special repellent sprays that could also be of assistance, but their effectiveness is sometimes questionable. With Lyme disease, the tips above and knowledge of the symptoms is the best way of minimizing the potential harmful effects of the disease. With tick-meningoencephalitis however, vaccination is certainly the best course of action to be entirely safe from the disease.

Should you find a tick on you, here are some useful tips. To safely remove a tick, Dr. Yanová recommends that you disinfect the area and then proceed to use tweezers to grasp the tick gently as close to the skin as possible and twist it in one direction. Alternatively, you can gently move it back and forth. However, make sure that you do not pull it out with force. That could result in you not fully removing the entire tick. When you are done, disinfect the area once more and you are done. Should some of the symptoms described earlier occur, please consult your doctor immediately.

Vaccination at CMC

Currently, vaccinations can be carried out throughout the entire year. For optimal results however, it is necessary to comply with vaccination schedules of individual vaccines. CMC uses the FSME-IMMUN Inject vaccine, which is produced in two types, one named Junior for children and adolescents (1-16 years old) and the other Adult (above the age of 16). Application in line with the standard vaccination schedule is split into three applications, where the second one follows the first after 1-3 months and the third one 5-12 months after the second. However, it is important to realize that a person is only protected from infection 14 days following the second dose. Protection lasts for around one year. Following the third dose, protection lasts for approximately three years. For children and adolescents, the period during which they are protected is even longer. Booster vaccinations take place in 3-5 year intervals following the first vaccination.
During the summer months, it is possible to vaccinate yourself within an accelerated vaccination schedule where time-saving occurs between the first and second application. The second dose follows the first just 14 days later and the third after 5-12 months.